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©The Author(s) 2022.
World J Gastroenterol. Feb 28, 2022; 28(8): 840-852
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.840
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.840
Table 1 Baseline characteristics of the study population
Variables | Before matching | After matching | ||||
ESD (n = 123) | Surgery (n = 562) | P value | ESD (n = 119) | Surgery (n = 119) | P value | |
Age, yr, mean SD | 55.3 12.4 | 53.0 11.8 | < 0.001 | 56.6 11.9 | 55.6 11.9 | 0.546 |
Male, n (%) | 68 (55.3) | 282 (50.2) | 0.305 | 67 (56.3) | 57 (47.9) | 0.194 |
Comorbidity, n (%) | ||||||
Hypertension | 44 (35.8) | 143 (25.4) | 0.020 | 41 (34.5) | 40 (33.6) | 0.891 |
Diabetes | 21 (17.1) | 65 (11.6) | 0.095 | 19 (16.0) | 15 (12.6) | 0.459 |
Cerebrovascular disease | 8 (6.5) | 18 (3.2) | 0.113 | 7 (5.9) | 2 (1.7) | 0.171 |
Respiratory disease | 7 (5.7) | 29 (5.2) | 0.811 | 6 (5.0) | 6 (5.0) | - |
Liver disease | 3 (2.4) | 26 (4.6) | 0.275 | 3 (2.5) | 3 (2.5) | - |
Renal disease | 2 (1.6) | 4 (0.7) | 0.294 | 1 (0.8) | 1 (0.8) | - |
ASA physical status1, n (%) | 0.022 | 0.254 | ||||
1 | 101 (82.1) | 503 (89.5) | 100 (84.0) | 106 (89.1) | ||
2 | 22 (17.9) | 59 (10.5) | 19 (16.0) | 13 (10.9) | ||
Tumor location, n (%) | < 0.001 | 0.822 | ||||
Upper third | 8 (6.5) | 55 (9.8) | 8 (6.7) | 6 (5.0) | ||
Middle third | 97 (78.9) | 321 (57.1) | 93 (78.2) | 93 (78.2) | ||
Lower third | 18 (14.6) | 186 (33.1) | 18 (15.1) | 20 (16.8) | ||
Lesion size, mm, n (%) | 0.430 | 0.418 | ||||
10 | 30 (24.4) | 105 (18.7) | 28 (23.5) | 19 (16.0) | ||
10-20 | 50 (40.7) | 224 (39.9) | 50 (42.0) | 49 (41.2) | ||
20-30 | 24 (19.5) | 133 (23.7) | 22 (18.5) | 28 (23.5) | ||
> 30 | 19 (15.4) | 100 (17.8) | 19 (16.0) | 23 (19.3) | ||
Gross morphology type1, n (%) | 0.315 | 0.760 | ||||
Elevated | 33 (26.8) | 127 (22.6) | 29 (24.4) | 27 (22.7) | ||
Flat or depressed | 90 (73.2) | 435 (77.4) | 90 (75.6) | 92 (77.3) | ||
Helicobacter pylori infection, n (%) | 64 (51.2) | 316 (56.2) | 0.397 | 61 (51.3) | 60 (50.4) | 0.897 |
ESD indication, n (%) | 0.183 | 0.183 | ||||
Within expanded indication | 80 (65.0) | 329 (58.5) | 78 (65.5) | 68 (57.1) | ||
Beyond expanded indication | 43 (35.0) | 233 (41.5) | 41 (34.5) | 51 (42.9) | ||
Histology appearance, n (%) | < 0.001 | 0.794 | ||||
Poorly differentiated carcinoma | 56 (45.5) | 151 (26.9) | 52 (43.7) | 54 (45.4) | ||
Signet ring cell carcinoma | 67 (54.5) | 411 (73.1) | 67 (56.3) | 65 (54.6) |
Table 2 Clinical outcomes and adverse events of early gastric cancer resection according to treatment modality
Variables | ESD (n =119) | Surgery (n = 119) | P value |
Median hospital stay, d (IQR) | 4.0 (4.0-5.0) | 9.0 (8.0-9.0) | < 0.001 |
ICU admission, n (%) | 1 (0.8) | 0 (0.0) | - |
30-d readmission, n (%) | 3 (2.5)1 | 2 (1.7)2 | - |
Operation-related death, n (%) | 1 (0.8) | 0 (0.0) | - |
Complication, n (%) | 14 (11.8) | 7 (5.9) | 0.110 |
Bleeding (early/late) | 8/0 | 0/0 | |
Perforation (early/late) | 5/0 | N/A | |
Pneumonia (early/late) | 1/0 | 0/0 | |
Anastomosis site leakage (early/late) | N/A | 1/0 | |
Adhesion or bowel obstruction (early/late) | 0/0 | 1/2 | |
Hernia (early/late) | N/A | 1/2 |
Table 3 Incidence and characteristics of recurrent tumors after initial treatment (endoscopic submucosal dissection or surgery)
Variables | ESD (n = 119) | Surgery (n = 119) | P value |
Recurrence, n (%) | 7 (5.9) | 2 (1.7) | 0.171 |
Local recurrence | 4 (3.4) | N/A | |
Adenoma | 0 (0.0) | N/A | |
Cancer | 4 (3.4) | N/A | |
Differentiated | 3 (2.5) | N/A | |
Undifferentiated | 1 (0.8) | N/A | |
Synchronous lesion | 0 (0.0) | 1 (0.8) | |
Adenoma | 0 (0.0) | 0 (0.0) | |
Cancer | 0 (0.0) | 1 (0.8) | |
Differentiated | 0 (0.0) | 0 (0.0) | |
Undifferentiated | 0 (0.0) | 1 (0.8) | |
Metachronous lesion | 3 (2.5) | 0 (0.0) | |
Adenoma | 1 (0.8) | 0 (0.0) | |
Cancer | 2 (1.7) | 0 (0.0) | |
Differentiated | 1 (0.8) | 0 (0.0) | |
Undifferentiated | 1 (0.8) | 0 (0.0) | |
Distant metastasis | 0 (0.0) | 1 (0.8) |
Table 4 Clinical and tumor information for recurrent patients
Age | Sex | Location | Size (mm) | Morphology | Histology | Initial treatment | Recurrence type | Pathology of recurred lesion | Recurrence location | Recurrence time (mo) | Treatment for recurred lesion |
61 | F | Middle 1/3 | 6 | Flat | SRC | ESD | Metachronous lesion | Undifferentiated cancer | Lower 1/3 | 70 | ESD |
62 | M | Middle 1/3 | 22 | Flat | SRC | ESD | Local recurrence | Undifferentiated cancer | Middle 1/3 | 6 | Surgery |
68 | F | Middle 1/3 | 68 | Flat | PDA | ESD | Metachronous lesion | Differentiated cancer | Upper 1/3 | 50 | ESD |
46 | M | Middle 1/3 | 60 | Flat | PDA | ESD | Local recurrence | Differentiated cancer | Middle 1/3 | 3 | Surgery |
50 | F | Middle 1/3 | 25 | Depressed | PDA | ESD | Local recurrence | Differentiated cancer | Middl1 1/3 | 12 | ESD |
62 | M | Middle 1/3 | 40 | Elevated | PDA | ESD | Local recurrence | Differentiated cancer | Middle 1/3 | 6 | Surgery |
56 | F | Lower 1/3 | 8 | Flat | PDA | ESD | Metachronous lesion | Adenoma | Middle 1/3 | 23 | ESD |
66 | M | Lower 1/3 | 15 | Flat | PDA | Surgery | Synchronous lesion | Undifferentiated cancer | Upper 1/3 | 5 | Surgery |
64 | M | Middle 1/3 | 10 | Elevated | SRC | Surgery | Distant metastasis | Undifferentiated cancer | Peritoneum | 122 | Conservative care |
Table 5 Cox proportional hazard model for risk of recurrence after initial treatment
Variables | Adjusted hazard ratio (95% confidence interval) | P value |
Treatment modality | ||
Surgery | 1.0 | |
ESD | 5.2 (1.0-25.8) | 0.045 |
Indication with any treatment modality | ||
Within expanded indication | 1.0 | |
Beyond expanded indication | 1.4 (0.4-5.4) | 0.585 |
Indication with ESD | ||
ESD for the lesion within expanded indication | 1.0 | |
ESD for the lesion beyond expanded indication | 2.8 (0.6-12.4) | 0.183 |
- Citation: Lee GH, Lee E, Park B, Roh J, Lim SG, Shin SJ, Lee KM, Noh CK. Long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated intramucosal gastric cancer regardless of size. World J Gastroenterol 2022; 28(8): 840-852
- URL: https://www.wjgnet.com/1007-9327/full/v28/i8/840.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i8.840